Wai Sheng Xuan Supervised by:

1101A11688 MBBS Batch 3 Ms. Caren

1.) Anatomy of Larynx
Larynx lies in the midline, anterior
to the hypopharynx/laryngopharynx

from root of tonguetrachea

C3 to C6 in Adult Males (higher in

Adult females & Children)

44mm in Males, 36mm in Females

Constituted by Cartilages,
which are connected by
Joints + Ligaments + Membranes ,
moved by Muscles.

Larynx is covered by loose mucous

membranes EXCEPT over the:
- Vocal Ligament
- Posterior surface of Epiglottis
Larynx Cartilages
 Larynx Cartilages
Total 9 Cartilages:
3 Unpaired (Thyroid cart, Cricoid cart, Epiglottis cart)
+ 3 Paired (Arytenoid cart, Corniculate cart, Cuneiform cart)
1.) Thyroid Cartilage (Thyrus = Roman Shield)
- Largest cartilage, made of Hyaline Cartilage.
- 2 Laminae/Alae that fuse in the midline, 90 Deg in Men , 120 Deg in Women
Laryngeal prominence Adams Apple (Absence post-trauma in men indicates #)
- Posterosuperior angles Superior Cornua (connected by Lateral Thyrohyoid
Ligament ~ Greater Cornua of Hyoid Bone)
- Posteroinferior angles Inferior Cornua (articulates with Cricoid Cartilage via
Cricothyroid Joint)
 Larynx Cartilages
2. Cricoid Cartilage (Krikos = Ring)
- Is the only complete cartilaginous ring in the airway, does not collapse during respi
- Thick & strong to support the larynx above
- Resembles a Signet Ring, narrow anteriorly (Arch) & broad posteriorly (Lamina)
- Made of Hyaline Cartilage.
 Larynx Cartilages
3. Epiglottis
- Is a thin leaf-like sheet of Fibroelastic Cartilage.
- Upper border is free & projected upwards towards
the tongue (attached by Median Glossoepiglottic
fold) & behind the Hyoid bone (attached by
Hyoepiglottic Ligament)
- Stalk is thin, directed downwards & is attached to
the inner surface of the angle of 2 thyroid laminae.
- Right & Left margins attached to Aryepiglottic
folds. (so the Aryepiglottic muscles can close the
inlet during swallowing)
- Posterior surface is covered by mucous membrane ,
and presents a tubercle in the lower part.
 Larynx Cartilages
4. Arytenoid cartilages
- 2 Pyramidal Shaped cartilages lying above lamina of Cricoid cartilage.
- Apex (curved posteromedially cuneiform cartilage)
- Base (Concave upper border cricoid lamina)
- Anterior surface (prolonged to form Vocal Process ~ Vocal Lig & Vocalis attch)
- Lateral surface (prolonged to form Muscular Process ~ attch Lateral Cricoarytenoid
anteriorly + attch Posterior Cricoarytenoid posteriorly)
- Posterior surface (triangular)
Larynx Membranes, Ligaments & Spaces
1.) Quadrangular Membrane
- Upper Edge Stretches from
lateral edge of epiglottis on each
side (Aryepiglottic fold)
inserts on aterolateral surface
of arytenoid along its whole
height , leaving Inferior free edge.
(Vestibular Folds/Ventricular folds)

2.) Cricovocal Ligament

-Arises from inner aspect of
cricoid arches climb
superpmedially thicken to form
Vocal Ligaments.
- 2 Vocal Ligaments unite to form
Anterior Commissure Ligament of
Broyles.
- When the Vocal Ligaments are
covered by mucous membrane,
forms the TRUE vocal folds.

3.) Thyroepiglottic Ligament

Larynx Membranes, Ligaments & Spaces
1. Pre-epiglottic space
Horseshoe shaped space that contains fibrofatty
tissue, bounded by Hyoid bone, thyrohyoid
membrane, hypoepiglottic ligament, thyroepiglottic
ligament & epiglottis.

Tumour may enter from anterior commissure or supraglottic

extension
to become continuous with paraglottic space.

2. Paraglottic Space
Space outside of Conus Elasticus & Quadrangular
membrane. Consists of fibrofatty tissues.

Tumour from supraglottic space may extd subglottic area

deeply via Transglottic Extension (without superficial appearance
on mucosa)

3. Reinkes Space
Superficial Lamina propria of True vocal fold, lacks
lymphatics & vessels.

4. Subglottic Space
Tumours in subglottic region presents late.
 Larynx Membranes, Ligaments & Spaces
Piriform fossa Smugglers fossa
- lies btw quadrate membrane & medial side of thyroid cartilage.
- Diamonds, drugs, stones.
- Transversed by Internal Laryngeal Nerve (punctured by fish bone)

Large foreign vs. Small foreign body

- Large foreign bodies block laryngeal inlet
suffocation
- Small foreign bodies lodge in laryngeal ventricle
reflex closure of glottis
Larynx Membranes, Ligaments & Spaces
Larynx Intrinsic Muscles
Larynx Intrinsic Muscles
Larynx Intrinsic Muscles
Larynx Intrinsic Muscles
 Larynx Intrinsic Muscles

Tumours
Larynx Arterial Supply
Larynx Nerve Supply
 Larynx Nerve Supply
MOTOR: All intrinsic muscles of larynx are supplied by
Recurrent Laryngeal Nerve, EXCEPT Cricothyroid
(tensor) by External Laryngeal Nerve.
Damage to Recurrent Laryngeal Nerve
- vocal cord paralysis
- Mediastinal Tumours (L Recur is longer)
External Laryngeal Nerve damage
- low pitch , hoarseness

SENSORY: (cough reflex)

- Internal Laryngeal N Mucous membrane above level of vocal folds
- Recurrent Laryngeal N Mucous membrane below lvele of vocal folds
Larynx Lymphatic Drainage
Larynx Lymphatic Drainage
 Physiology
1. Protection of Lower Airway
(Tight adduction of vocal folds, Closure of vestibular folds, Anterior
displacement of arytenoids, Closure of epiglottis, Elevation of
larynx, Cessation of respi, Laryngeal Cough Reflex)
2. Phonation
1. Expired air
2. Vibrators
3. Resonators
4. Articulators

3. Air Entrapment (increase intrathoracic & intraabd P)

4. Respiration
Protection: Swallowing Reflex
Protection: Cough Reflex
 References
BD Chaurasias Human Anatomy Volume 3 (5th
Edition)
Essential Clinical Anatomy (4th Edition)
Diseases of Ear, Nose and Throat: P. L. Dhingra,
Shruti Dhingra (4th Edition)